小剂量地塞米松对全髋关节置换术后功能的影响

目的探讨使用两次小剂量地塞米松对全髋关节置换术后疼痛和康复的临床疗效和安全性。 方法选取2017年10月至2018年10月惠州市第三人民医院骨科需要行初次THA患者，排除对地塞米松过敏，酒精或药物滥用者，存在风湿免疫系统疾病，手术前7 d给予任何强阿片类药物和其他心肺功能缺陷的患者。共80例THA患者，采用随机数表法，随机分为对照组和实验组，对照组麻醉诱导前静脉注射10 mg地塞米松；实验组在麻醉诱导前和术后12 h接受了两种剂量的10 mg地塞米松。比较C反应蛋白(CRP)、白介素6(IL-6)和视觉模拟疼痛评分(VAS)、术后恶心呕吐(PONV)发生率、术后疲劳程度、髋关节活动度(ROM)、住院时间、镇痛药和止吐消耗量及并发症。采用独立样本t检验比较两组患者围手术期CRP、IL-6、VAS、疲乏程度及ROM等；采用卡方检验比较性别、PONV及并发症。 结果实验组术后24 h(t ＝－1.259，P<0.05)、48 h(t＝－2.684，P<0.05)、72 h(t＝－3.669，P<0.05)的CRP低于对照组。同样的，实验组术后24 h(t＝－1.954，P<0.05)、48 h(t＝－3.418，P<0.05)、72 h(t＝－4.985，P<0.05)的IL-6水平均低于对照组。实验组术后24 h(t＝－2.647，P<0.05)、48 h(t＝－2.12，P<0.05)、72 h(t＝－1.367，P<0.05)的VAS评分低于对照组。实验组相比对照组术后PONV发生率更低(χ² ＝1.067，P<0.01)、术后疲劳减轻(t＝－2.154，P<0.01)、镇痛药和止吐药消耗量更少。实验组相比对照组，缩短了住院时间(t＝0.517，P<0.01)，增加了关节活动度(t＝－3.228，P<0.01)。两组均未发生早期手术切口感染或消化道出血。 结论全髋关节置换术患者应用两次剂量地塞米松，可降低术后CRP、IL-6水平，增加镇痛效果，减少PONV发生率和术后疲劳，但不增加早期手术切口感染和消化道出血的风险。

Effects of low dose dexamethasone on patients of total hip arthroplasty

ObjectiveTo investigate the clinical efficacy and safety of using twice low-dose dexamethasone in the treatment of pain and rehabilitation following total hip arthroplasty (THA). MethodsFrom October 2017 to October 2018, patients in the Orthopedics Center of the Third People’s Hospital of Huizhou who needed primary THA were selected. The patients with dexamethasone allergy, alcohol or drug abuse, rheumatic immune system diseases, and the patients who were given any strong opioids or other cardiopulmonary defects 7d before surgery were excluded. A total of 80 THA patients were divided into control group and experimental group by random number table method. The control group received 10 mg dexamethasone intravenously before anesthesia induction and the experimental group received two doses of 10 mg dexamethasone before and 12 h after anesthesia induction. C-reactive protein (CRP), interleukin-6 (IL-6) levels and visual analogue scale (VAS), postoperative incidence of nausea and vomiting (PONV), postoperative fatigue, hip range of motion (ROM), length of stay, analgesics and antiemetic consumption and complications were compared by t test or chi-square test. ResultsThe level of CRP in the experimental group was lower than that in the control group in 24 h (t =-1.259, P<0.05), 48h (t=-2.684, P<0.05)and 72 h (t=-3.669, P<0.05)postoperatively. The level of IL-6 in the experimental group was lower than that in the control group in 24 h (t=-1.954, P<0.05), 48h (t=-3.418, P<0.05)and 72 h (t =-4.985, P<0.05)postoperatively. VAS of the experimental group was lower than that of the control group at 24h (t =-2.647, P<0.05), 48 h (t=-2.12, P<0.05)and 72 h (t=-1.367, P<0.05)postoperatively. Compared with the control group, the incidence of PONV was lower(χ² =1.067, P<0.01), postoperative fatigue was alleviated(t=-2.154, P<0.01), and the consumption of analgesics and antiemetic drugs was less in the experimental group than in the control group. Compared with the control group, the experimental group shortened the length of stay(t=0.517, P<0.01) and increased the ROM(t=-3.228, P<0.01). There was no early operative incision infection or gastrointestinal bleeding in both groups. ConclusionTwo doses of dexamethasone in patients with THA can decrease the level of CRP, IL-6, increase the analgesic effect, and reduce the incidence of PONV and postoperative fatigue, which would not increase the risk of early surgical incision infection and gastrointestinal bleeding.